Provider Demographics
NPI:1215988092
Name:CHI, PETER L (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:L
Last Name:CHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95378-0424
Mailing Address - Country:US
Mailing Address - Phone:209-834-8697
Mailing Address - Fax:209-830-9390
Practice Address - Street 1:1770 N TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2431
Practice Address - Country:US
Practice Address - Phone:209-834-8697
Practice Address - Fax:209-830-9390
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA038404OtherHILLS PHYSICIAN
CAG92117Medicare UPIN
CA00A538560Medicare ID - Type Unspecified